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April 1995

The Influence of Race on the Use of Surgical Procedures for Treatment of Peripheral Vascular Disease of the Lower Extremities

Author Affiliations

From the Department of Health Care Policy, Harvard Medical School (Drs Guadagnoli, Ayanian, and McNeil); the Division of General Medicine, Section on Health Services and Policy Research, Department of Medicine, Brigham and Women's Hospital (Dr Ayanian); and the Division of Vascular Surgery, Department of Surgery, New England Deaconess Hospital (Drs Gibbons and LoGerfo), Boston, Mass.

Arch Surg. 1995;130(4):381-386. doi:10.1001/archsurg.1995.01430040043006

Objective:  To assess whether rates of amputation and leg-sparing surgery for peripheral vascular disease of the lower extremities differ between African-American and white patients.

Design:  Retrospective cohort study using Medicare claims data for 1989 and 1990.

Setting:  A total of 3313 hospitals in the United States.

Patients:  Random sample of 19 236 Medicare Part A enrollees who underwent amputation and/or leg-sparing surgery for peripheral vascular disease.

Main Outcome Measures:  Adjusted odds of toe and/or foot amputation, below-knee amputation, above-knee amputation, lower extremity arterial vascularization, and percutaneous transluminal angioplasty for African Americans relative to whites, controlling for case-mix, region, and hospital characteristics.

Results:  African-American patients were significantly more likely than white patients to undergo above-knee, below-knee, and toe and/or foot amputation and significantly less likely to undergo lower-extremity arterial revascularization and percutaneous transluminal angioplasty. These associations occurred for diabetic patients and nondiabetic patients but were more pronounced among patients who did not have diabetes.

Conclusions:  Potential explanations include unmeasured factors such as severity of disease and the technical expertise available at hospitals or other factors such as lack of compliance with medical treatment and racespecific treatment decisions by providers. Whatever the cause, interventions aimed toward reducing the number of amputations among African Americans are needed. Further work is required to determine where such interventions should be targeted.(Arch Surg. 1995;130:381-386)